Choix des examens du métabolisme du fer en cas de suspicion de carence en fer - Rapport d'évaluation - Selection of iron metabolism tests in cases where iron deficiency is suspected - Abstract

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Posted on Jun 14 2011 The French health insurance agency asked the HAS to determine strategies for the use of iron metabolism markers. In fact, the volume of procedures carried out in relation to all such tests which are reimbursed by the health insurance agency increased by 109% between 2000 and 2008. Furthermore, some tests appear to be redundant or irrelevant according to the latest French recommendations, (ANDEM, 1995). In this assessment, the HAS has focused on iron deficiency and has not looked at iron overloads, since professional recommendations issued by the HAS in 2005 on haemochromatosis still appear to be valid Posted on Jun 14 2011

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Biologie Médecine

Selection of iron metabolism tests in cases where iron deficiency is suspected Haute Autorité de Santé (HAS), Saint-Denis La Plaine, France Author : Cécile CIANGURA, HAS, France Aim The French health insurance agency asked the HAS to determine strategies for the use of iron metabolism markers. In fact, the volume of procedures carried out in relation to all such tests which are reimbursed by the health insurance agency increased by 109% between 2000 and 2008. Furthermore, some tests appear to be redundant or irrelevant according to the latest French recommendations, (ANDEM, 1995). In this assessment, the HAS has focused on iron deficiency and has not looked at ir on overloads, since professional recommendations issued by the HAS in 2005 on haemochromatosis still appear to be valid. Conclusions and results The HAS recommends that the markers to be measured in order to identify an iron deficiency are : - as a priority: serum ferritin; a low ferritin lev el confirms the diagnosis of an iron deficiency and it is not necessary to measure other iron markers in this case ; - in the case of inflammation, chronic renal impairment or when the serum ferritin result is not conclusive (normal or high level even though an iron deficiency is strongly suspected): serum iron in conjunction with transferrin (allowing the transferrin saturation coefficient to be calculated) may be useful for diagnostic purposes ; Consideration should be given to the need to take account of the clinical context and of haemogram parameters. The measurement of iron alone or the combination of serum iron + ferritin without transferrin is not indicated in any circumstances in order to diagnose an iron deficiency. The role of soluble transferrin receptors is limite d to rare situations in a specialist environment. Furthermore, it seems to be necessary to meet certain sampling conditions: samples for the measurement of iron metabolism markers should not be taken during or immediately after an episode of acute inflammation; in the event of repeated measurements, it is preferable for these to be carried out in the same laboratory; if serum iron and transferrin are measured, samples must be collected in the morning with the patient fasted. There is no consensus regarding the interpretation of results for iron metabolism markers during pregnancy and in children. .../

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